Longitudinal-positioning indicator and marking grid

ABSTRACT

A longitudinal-positioning indicator, improved marking grid, and a method of use. The longitudinal-positioning indicator includes a substrate that has a first side on which a set of longitudinal-positioning guidelines are disposed, the set of longitudinal-positioning guidelines configured to indicate a position along a length of the longitudinal-positioning guidelines based on a cross-section of the longitudinal-positioning indicator taken substantially orthogonally to the set of longitudinal-positioning guidelines. The substrate also has a second side that is at least partially coated with an adhesive.

BACKGROUND Technical Field

Novel aspects of the present disclosure relate to a guide for providingreference indicators for use in radiographic imaging. More particularly,the present disclosure is directed to a longitudinal-positioningindicator and an improved marking grid for use in radiographic imaging,which can provide orthogonal coordinates for identifying locations on apatient's body for performing medical procedures.

Background

Computerized tomography (CT) scanning is a radiographic imagingprocedure that creates cross-sectional images in the transverse plane,colloquially described as “slices”, to depict target internal structures(e.g., organs or tumors) of a patient within the scanned areas.Appearance of objects depicted on a CT image is based in part onradiotransparency. Denser substances, such as bones and rigid implantsare substantially radiopaque and appear on a radiographic image aswhite. Body cavities are radiolucent and appear as dark regions. Softtissue is generally more radiopaque than body cavities and appear invarious shades of gray based on density.

A CT scanning system generally includes a scanner, a bed configured toadvance a patient through the scanner, and a computer that constructsthe image slices based on the image data captured by the scanner. Toprovide some context that can be used identify the location of thetarget internal structures, marking grids with substantially radiopaqueguidelines can be adhered to a patient so that the marking grids appearon the radiographic image. However, conventionally available markinggrids only include lateral-positioning guidelines for identifying, froma radiographic image, a lateral position for location determination. Thepatient's table position is used to provide a second, longitudinalposition for location determination. However, translation or rotation ofthe patient's body relative to the scanning table can render thelongitudinal position inaccurate.

SUMMARY OF THE INVENTION

Novel aspects of the disclosure are directed to alongitudinal-positioning indicator for use in radiographic imagingprocedures, an improved marking grid including thelongitudinal-positioning indicator, and a method of use. Thelongitudinal-positioning indicator includes a substrate that has a firstside on which a set of longitudinal-positioning guidelines are disposed,the set of longitudinal-positioning guidelines configured to indicate aposition along a length of the longitudinal-positioning guidelines basedon a cross-section of the longitudinal-positioning indicator takensubstantially orthogonally to the set of longitudinal-positioningguidelines. The substrate also has a second side that is at leastpartially coated with an adhesive.

The improved marking grid includes a substrate including a first sideand a second side that is at least partially coated with an adhesive.The marking grid also includes a set of lateral-positioning guidelinessupported by the substrate and a set of longitudinal-positioningguidelines supported by the substrate. The set of lateral-positioningguidelines and the set of longitudinal-positioning guidelines areconfigured to provide a pair of orthogonal coordinates that indicate alocation within an area bounded by the marking grid, the location basedon a cross-section of the marking grid taken substantially orthogonallyto the set of lateral-positioning guidelines.

The method is directed to needle insertion into a patient within an areadefined by a marking grid, the marking grid including a set oflateral-positioning guidelines and a set of longitudinal-positioningguidelines configured to provide reference markers based on across-section of the marking grid taken substantially orthogonally tothe set of lateral-positioning guidelines, the method including thesteps of identifying, from a radiographic image, a target internalstructure; identifying, from reference markers associated with the setof lateral-positioning guidelines, a lateral-positioning coordinate forthe target internal structure; identifying, from reference markersassociated with the set of longitudinal-positioning guidelines, alongitudinal-positioning coordinate for the target internal structure;and determining, with reference to indicators on the marking grid, alocation for the needle insertion using the longitudinal-positioningcoordinate and the lateral-positioning coordinate.

Other aspects, embodiments and features of the invention will becomeapparent from the following detailed description of the invention whenconsidered in conjunction with the accompanying figures. In the figures,each identical, or substantially similar component that is illustratedin various figures is represented by a single numeral or notation. Forpurposes of clarity, not every component is labeled in every figure. Noris every component of each embodiment of the invention shown whereillustration is not necessary to allow those of ordinary skill in theart to understand the invention.

BRIEF DESCRIPTION OF THE FIGURES

The novel features believed characteristic of the invention are setforth in the appended claims. The invention itself, however, as well asa preferred mode of use, further objectives, and advantages thereof,will be best understood by reference to the following detaileddescription of illustrative embodiments when read in conjunction withthe accompanying figures, wherein:

FIGS. 1A and 1B are drawings depicting a plan view and a perspectiveview of a longitudinal-positioning indicator, respectively, inaccordance with an illustrative embodiment;

FIGS. 2A-2E are drawings depicting cross-sectional views of thelongitudinal-positioning indicator taken along lines 2 a-2 a, 2 b-2 b, 2c-2 c, 2 d-2 d, and 2 e-2 e, respectively, in FIG. 1B;

FIG. 3 is a drawing depicting a plan view of a longitudinal-positioningindicator applied to a marking grid according to an illustrativeembodiment;

FIG. 4 is a drawing depicting a plan view of a longitudinal-positioningindicator applied to a marking grid according to another illustrativeembodiment;

FIG. 5 is a drawing depicting a plan view of a longitudinal-positioningindicator in accordance with another illustrative embodiment;

FIG. 6 is a drawing depicting a plan view of a longitudinal-positioningindicator in accordance with yet another illustrative embodiment;

FIG. 7 is a drawing illustrating the application of marking grid with asupplemental longitudinal-positioning indicator onto a patient inaccordance with an illustrative embodiment;

FIG. 8 is a drawing illustrating a radiographic image of a patient takenalong line 8-8 in FIG. 7 ;

FIGS. 9A and 9B are drawings depicting a plan view and a perspectiveview, respectively, of a marking grid with a set of lateral-positioningguidelines and a set of longitudinal-positioning guidelines inaccordance with yet another illustrative embodiment;

FIG. 10 is a schematic depicting a plan view of a marking grid with aset of lateral-positioning guidelines and a set oflongitudinal-positioning guidelines in accordance with yet anotherillustrative embodiment;

FIG. 11 is a schematic depicting a plan view of a marking grid with aset of lateral-positioning guidelines and a set oflongitudinal-positioning guidelines in accordance with yet anotherillustrative embodiment;

FIG. 12 is a drawing depicting a plan view of a marking grid with a setof lateral-positioning guidelines and a set of longitudinal-positioningguidelines in accordance with yet another illustrative embodiment;

FIG. 13 is a drawing depicting a cross-sectional view of a marking gridin FIG. 12 taken along line 13-13;

FIG. 14 is a drawing depicting a plan view of a marking grid with a setof lateral-positioning guidelines and a set of longitudinal-positioningguidelines in accordance with yet another illustrative embodiment;

FIG. 15 is a drawing depicting a cross-sectional view of a marking gridin FIG. 14 taken along line 15-15; and

FIG. 16 is a flowchart of a process for location identification using amarking grid in accordance with an illustrative embodiment.

DETAILED DESCRIPTION

Marking grids are commonly used during radiographic imaging procedures,such as a CT-guided biopsy procedure, to provide a radiologist ortechnician, also referred to herein as a “user”, with reference markersfor biopsy needle insertion. Conventional marking grids, such as markinggrid 300 depicted in FIG. 3 , generally include a plurality oflateral-positioning guidelines, i.e. a series of elongated, parallel,and coextensive guidelines that are regularly spaced apart and formedfrom a radiopaque substance so that the guidelines appear clearly in aradiographic image. Neighboring guidelines may be separated from oneanother by an elongated aperture. The marking grid can be applied to arecipient, also referred to herein as “a patient,” so that when therecipient is in a supine position, the elongated guidelines are alignedsubstantially orthogonally to the transverse plane and positioned overan area of interest containing an internal structure to be scanned.

When a CT scan is performed of the area of interest, a predeterminednumber of sequential CT images are captured, which depict the transverseslices of the internal structure along with the guidelines from themarking grid. The guidelines appear in cross-section on each of the CTimages as solid white circles. Needle insertion into the scannedinternal structure can be achieved by determining, from a selected CTimage, depth and lateral positioning (i.e., a lateral-positioningcoordinate) based on the reference markers, and longitudinal positioning(i.e., a longitudinal-positioning coordinate) based on the patient'stable position. Thereafter, the location for needle insertion can beidentified on a user's skin with reference to the lateral-positioningguidelines on the marking grid, which establishes thelateral-positioning coordinate, and a patient's table position, whichestablishes the longitudinal-positioning coordinate.

Inadvertent translation and/or rotation of the patient on the scanningtable can result in inaccurate location determination. Thus, novelaspects of this disclosure recognize a need for providing a referencemarker that can indicate a longitudinal position in a radiographic imageso that a single radiographic image can be used to determine alateral-positioning coordinate, longitudinal-positioning coordinate, anda depth for biopsy needle insertion. The lateral andlongitudinal-positioning coordinates are provided by indicators that canconvey the positioning information from a cross-section of theindicators, taken in the transverse plane so that the positioninginformation can be determined from a radiographic image.

In the disclosure that follows, FIGS. 1-7 are directed to alongitudinal-positioning indicator that can be applied to existingmarking grids that are only capable of providing a lateral-positioningcoordinate. FIGS. 8-14 are directed to an improved marking grid thatincludes lateral-positioning guidelines and longitudinal-positioningguidelines that are capable of providing both a lateral-positioningcoordinate and a longitudinal-positioning coordinate.

FIGS. 1A and 1B are drawings depicting a plan view and a perspectiveview, respectively, of a longitudinal-positioning indicator inaccordance with an illustrative embodiment. The longitudinal-positioningindicator 100 has a length L that extends in the longitudinal directionand a width W that extends in a lateral direction that is substantiallyorthogonal to the longitudinal direction. As used herein, the lateraldirection may also be referred to in the alternative as the transversedirection. The longitudinal-positioning indicator 100 is configured toindicate a relative position along the length L of thelongitudinal-positioning indicator 100 from a cross-section taken in atransverse plane. Thus, the longitudinal-positioning indicator 100 canbe used to indicate a relative position along the length L of thelongitudinal-positioning indicator 100 from a radiographic image, asdescribed in more detail in the discussion of the various embodimentsthat follow.

The longitudinal-positioning indicator 100 includes a substrate 102 thatis generally radiolucent. The substrate 102 is flexible and can beelastic in some embodiments to conform to the contours of a patient'sbody. Non-limiting examples of materials for forming the substrate 102can include paper, plastic, or fabric. The substrate 102 has a firstside 102′ and a second side 102″ opposite to the first side 102′. Anadhesive 104 is applied to at least a portion of the second side 102″ toenable the longitudinal-positioning indicator 100 to be affixed totarget location, such as a marking grid or to a patient's skin. Prior touse, the longitudinal-positioning indicator 100 can be releasablyadhered to a releasable backing material 106 via the adhesive 104.

In this illustrative embodiment in FIGS. 1A and 1B, a set oflongitudinal-positioning guidelines 108 is disposed on the first side102′ of the longitudinal-positioning indicator 100. As used herein, theterm “set” means one or more. Thus, the set of longitudinal-positioningguidelines 108 can be a single guideline or two or morelongitudinal-positioning guidelines. With particular reference to FIGS.1A and 1B, the set of longitudinal-positioning guidelines 108 includesfive guidelines 108 a-108 e aligned at their respective first ends andextend in a longitudinal direction. As used herein, the “longitudinaldirection” corresponds to the length L of the longitudinal-positioningindicator 100 so that so that a cross-sectional view of thelongitudinal-positioning indicator 100 is orthogonal to each of theguidelines in the set of longitudinal-positioning guidelines 108.

Each of the guidelines in the set of longitudinal-positioning guidelines108 has a different length, arranged based on their respective lengths.For example, in the embodiment depicted in FIGS. 1A and 1B the set oflongitudinal-positioning guidelines 108 are arranged in order ofincreasing length from left to right, i.e., in a stairstep pattern. Inanother embodiment, as depicted in FIG. 5 , the set oflongitudinal-positioning guidelines 508 are aligned at their respectivesecond ends and are arranged in order of increasing length from left toright, i.e., in an inverted stairstep pattern.

The set of longitudinal-positioning guidelines 108 can be formed from asubstance that is at least partially radiopaque, or in some embodimentssubstantially entirely radiopaque. In another embodiment, the set oflongitudinal-positioning guidelines 108 is formed from substance thathas a radiopacity that is greater than the radiopacity of the substrate102 so that the structure associated with the substrate 102 can bedifferentiated from the structures associated with the set oflongitudinal-positioning guidelines 108 in a radiographic image. Forexample, the set of elongated indicators can be formed from metal wireor printed onto the substrate 102 using an ink that is at leastpartially radiopaque. In another embodiment, the set of elongatedindicators can be radiopaque particles suspended in a carrier, such asglue, which can be applied to the first side 102′ of the substrate 102.In other embodiments, rather than being disposed on the first side 102′of the substrate, the longitudinal-positioning guidelines 108 can bewholly or partially embedded within the substrate 102.

In this illustrative embodiment in FIGS. 1A and 1B, thelongitudinal-positioning indicator 100 includes an index 110 includingvalues 110 a and/or demarcations 110 b, each of which corresponds to alength of a guideline in the set of longitudinal-positioning guidelines108. For example, each of the values 110 a and/or demarcations 110 b inthe index 110 allows a user to identify a particular guideline in theset of longitudinal-positioning guidelines 108 quickly and easily. Byextrapolating each of the demarcations in a transverse direction, animaginary horizontal axis can be derived. Thus, when thelongitudinal-positioning indicator 100 is applied to a conventionalmarking grid, such as marking grid 300 in FIG. 3 or marking grid 400 inFIG. 4 , subsequently captured radiographic image will include referencemarkers for determining a longitudinal-positioning coordinate that canbe correlated to a location on a patient's skin with reference to theindex 110.

In this illustrative embodiment in FIGS. 1A and 1B, the substrate 102 oflongitudinal-positioning indicator 100 includes a body portion 102 athat supports the set of longitudinal-positioning guidelines 108 and anoptional margin portion 102 b. In some embodiments, the body portion 102a can be separated from the margin portion 102 b by a perforation 112that allows the body portion 102 a to be detached from the marginportion 102 b. The perforation 112 permits the body portion 102 a to beseparated from the margin portion 102 b so that thelongitudinal-positioning indicator 100 can be at least partially adheredto conventional marking grids, as depicted in FIGS. 3 and 4 , oralongside conventional marking grids to permit identification in alongitudinal direction.

In some embodiments, the perforation 112 extends through the substrate102, the adhesive 104, and the releasable backing material 106. In otherembodiments, the perforation 112 extends only through the releasablebacking material 106 so that the adhesive 104 is selectively exposedfrom either the body portion 102 a or the margin portion 102 b for easeof application.

FIGS. 2A-2E are drawings depicting cross-sectional views of thelongitudinal-positioning indicator taken along lines 2 a-2 a, 2 b-2 b, 2c-2 c, 2 d-2 d, and 2 e-2 e, respectively, in FIG. 1B.

As briefly discussed above, the set of longitudinal-positioningguidelines 108 can be used to indicate a longitudinal-positioningcoordinate, i.e., a position along a length L of thelongitudinal-positioning indicator 100 from a cross-section of thelongitudinal-positioning indicator 100. For example, a cross-section ofthe longitudinal-positioning indicator 100 taken along line 2A-2A willdepict five of the set of longitudinal-positioning guidelines 108, e.g.,108 a-108 e. A cross-section of the longitudinal-positioning indicator100 taken along lines 2B-2B will depict only four of the set oflongitudinal-positioning guidelines 108, e.g., 108 b-108 e. Across-section of the longitudinal-positioning indicator 100 taken alonglines 2C-2C will depict only three of the set oflongitudinal-positioning guidelines 108, e.g., 108 c-108 e. Across-section of the longitudinal-positioning indicator 100 taken alonglines 2D-2D will depict only two of the set of longitudinal-positioningguidelines 108, e.g., 108 d and 108 e. A cross-section of thelongitudinal-positioning indicator 100 taken along lines 2E-2E willdepict only one of the set of longitudinal-positioning guidelines 108,e.g., 108 e. Thus, from a cross-section of the longitudinal-positioningindicator 100, a relative position can be determined along a length L.

Because the set of longitudinal-positioning guidelines 108 are at leastpartially radiopaque, the set of longitudinal-positioning guidelines 108can serve as reference markers on a radiographic image. When used inconjunction with a marking grid that only includes a set oflateral-positioning guidelines, i.e., only provides alateral-positioning coordinate, the longitudinal-positioning indicator100 can provide a longitudinal-positioning coordinate for identifying alocation for biopsy needle placement without the need for referring to apatient's table position.

The longitudinal-positioning indicator 100 can be at least partiallyadhered to conventionally available marking grids. For example, thelongitudinal-positioning indicator 100 can be adhered entirely to aconventional marking grid, as depicted in FIG. 3 , or the partiallyadhered to the conventional marking grid as depicted in FIG. 4 .Although not depicted, the longitudinal-positioning indicator 100 can bealigned with a conventional marking grid but adhered entirely to apatient's skin.

FIG. 3 is a drawing depicting a plan view of a longitudinal-positioningindicator applied to a marking grid according to an illustrativeembodiment. The marking grid 300 is an example of a conventionallyavailable marking grid, which includes a substrate 302 on which aplurality of lateral-positioning guidelines 350 are disposed. Each ofthe lateral-positioning guidelines 350 are formed from a generallyradiopaque substance and are configured to provide reference markers ina radiographic image. The marking grid 300 also includes a plurality ofelongated apertures 352 extending substantially co-extensively with eachof the plurality of lateral-positioning guidelines 350. The marking grid300 can be used to determine a lateral-positioning coordinate in amanner that is known in the art. When used in conjunction with themarking grid 300, the longitudinal-positioning indicator 100 provides alongitudinal-positioning coordinate in the manner that was described indetail with reference to FIG. 2 .

In this illustrative embodiment in FIG. 3 , only the body portion 102 aof the longitudinal-positioning indicator 100 is used. In particular,the body portion 102 a is adhered directly to the marking grid 300. Ifthe longitudinal-positioning indicator 100 includes the optional marginportion 102 b, then the margin portion 102 b can be detached from thebody portion 102 a so that the body portion 102 a can be adhered to themarking grid 300. In one embodiment, the margin portion 102 b isdetached from the body portion 102 a along a perforation, such asperforation 112 that was described in more detail in FIGS. 1A and 1B,above. In another embodiment, the longitudinal-positioning indicator 100can be adhered directly to a patient's skin, positioned adjacent to themarking grid 300 with the set of longitudinal-positioning guidelines 108oriented substantially parallel to the set of lateral-positioningguidelines 306. In yet another embodiment, the longitudinal-positioningindicator 100 can be partially adhered to the marking grid 300, asdescribed in the figure that follows.

FIG. 4 is a drawing depicting a plan view of a longitudinal-positioningindicator applied to a marking grid according to another illustrativeembodiment. The marking grid 400 is an example of a conventionallyavailable marking grid, like marking grid 300 in FIG. 3 . The markinggrid 300 can be used to determine a lateral-positioning coordinate in amanner that is known in the art. When used in conjunction with themarking grid 400, the longitudinal-positioning indicator 100 provides alongitudinal-positioning coordinate in the manner that was described indetail with reference to FIG. 2 .

In this illustrative embodiment in FIG. 4 , only the margin portion 102b of the longitudinal-positioning indicator 100 is adhered to themarking grid 400. The body portion 102 a extends past the edge of themarking grid 400 and can be adhered directly to a patient's skin.However, in another embodiment the entirety of thelongitudinal-positioning indicator 100 in FIG. 4 can be adhered to themarking grid 400 if space permits, or the entirety of thelongitudinal-positioning indicator 100 can be adhered to a patient'sskin and positioned adjacent to the marking grid 400 with the set oflongitudinal-positioning guidelines 108 aligned substantially parallelto the lateral-positioning guidelines.

At least one benefit of applying the longitudinal-positioning indicator100 depicted in FIG. 4 is the ability to easily align thelongitudinal-positioning indicator 100 with the marking grid 400. Forexample, one side of the longitudinal-positioning indicator can bealigned with the marking grid 400, e.g., the margin portion 102 b can bealigned with the edge of the marking grid 400, while the releasablebacking material 106 is removed from the other side of thelongitudinal-positioning indicator 100 and adhered to a patient's skinor the marking grid 400. Thereafter, the releasable backing material 106can be removed from the one side of the longitudinal-positioningindicator 100 and adhered.

FIG. 5 is a drawing depicting a plan view of a longitudinal-positioningindicator in accordance with another illustrative embodiment. Thelongitudinal-positioning indicator 500 is similar to thelongitudinal-positioning indicator 100 depicted in FIGS. 1A and 1B,except that each of longitudinal-positioning guidelines 508 are alignedat their respective second ends and arranged in order of increasing sizefrom left to right, forming an inverted stair-step pattern.

FIG. 6 is a drawing depicting a plan view of a longitudinal-positioningindicator in accordance with yet another illustrative embodiment. Thelongitudinal-positioning indicator is similar to thelongitudinal-positioning indicator in FIG. 5 but includes a marginportion 602 b extending outwardly from the body portion 602 a. Themargin portion 602 b is formed from a set of tabs 602 b′ and 602 b″. Inthis illustrative embodiment, each of the tabs 602 b′ and 602 b″ areintegrally formed with the body portion 602 a of the substrate 602.However, in another embodiment, the set of tabs 602 b′ and 602 b″ areremovably attached to the body portion 602 a, e.g., via a perforatededge. In either embodiment, each of the tabs 602 b may be releasablyadhered to a releasable backing material that is detachable from thereleasable backing material adhered to the back of the body portion 602a to allow the releasable backing material of the set of tabs 602 b′and/or 602 b″ to be selectively exposed independently from thereleasable backing material adhered to the body portion 602 a.

FIG. 7 is a drawing illustrating the application of a marking grid and asupplemental longitudinal-positioning indicator onto a patient inaccordance with an illustrative embodiment. The marking grid 300 isapplied to the skin of patient 700 and oriented so that thelongitudinal-positioning guidelines are extended from head to foot,i.e., in the longitudinal direction. Further, the marking grid 300 isapplied to the patient 700 so that when the patient 700 is in a supineposition on the scanning table 702, the marking grid 300 and thelongitudinal-positioning indicator 100 is above the targeted internalstructure. Radiographic images of the patient 700 are taken in thetransverse plane, an example of which is depicted in FIG. 8 , takenalong line 8-8 in FIG. 7 . The longitudinal-positioning indicator 100can be adhered to the marking grid 300 before or after the marking grid300 is adhered to the skin of the patient 700 or after.

When radiographic images are taken of the patient 700, the set oflateral-positioning guidelines 350 from the marking grid 300 and the setof longitudinal-positioning guidelines 108 from thelongitudinal-positioning indicator 100 provide reference markers thatappear on the radiographic image 800, which can be used to identify alateral position and a longitudinal position, respectively, on thepatient's body for inserting a biopsy needle for tissue extraction. Forexample, a user analyzing the plurality of radiographic images taken ofa patient 700 may determine that a tissue sample should be extractedfrom location 802. Accordingly, the user can identify alateral-positioning coordinate from radiographic image 800 by countingthe number of guidelines 350 from a reference location, e.g., thelateral-positioning guideline 350′ closest to thelongitudinal-positioning indicator 100, or the lateral-positioningguideline 350′ separated from the others by the widest elongatedaperture 352. In this illustrative embodiment, a user can count thelateral-positioning guidelines 350 to determine that thelateral-positioning coordinate should be located between the third andfourth lateral-positioning guideline 350, in the area defined by theelongated aperture 352′. The user can also determine thelongitudinal-positioning coordinate based on the reference markersprovided by the set of lateral-positioning guidelines 108, and a depth Dfor needle insertion.

Thereafter, a location for needle placement on the skin of user 700 canbe identified from visual indicators on the marking grid 300 and thelongitudinal-positioning indicator 100. A visual indicator for thelateral-positioning coordinate can include a numerical value printed onthe marking grid 300 associated with each of the lateral-positioningguidelines 350 and a visual indicator for the longitudinal-positioningcoordinate can be the index 110 that was previously described in moredetail in FIGS. 1A and 1B.

FIGS. 9A and 9B are drawings depicting a plan view and a perspectiveview, respectively, of a marking grid with a set of lateral-positioningguidelines and a set of longitudinal-positioning guidelines inaccordance with yet another illustrative embodiment.

The marking grid 900 includes a substrate 902, which is like substrate102 in FIGS. 1A and 1B. Further, the substrate has a first side 902 aand a second side 902 b that is at least partially coated with anadhesive 904. In a non-limiting embodiment, a releasable backingmaterial 906 is adhered to the substrate 902 via the adhesive 904 priorto use. The substrate 902 supports the set of lateral-positioningguidelines 950 and the set of longitudinal-positioning guidelines 908.As previously described, the substrate 902 can be formed from asubstantially radiolucent material, whereas the set oflateral-positioning guidelines 950 and the set oflongitudinal-positioning guidelines 908 can be formed from asubstantially radiopaque material to provide a sufficient contrastbetween the substrate 902 and the positioning guidelines 908 and 950 ona radiographic image.

In this non-limiting embodiment in FIG. 9A, the set oflateral-positioning guidelines 950 includes seven elongated guidelines950 a-950 g of generally equal length, arranged in parallel fashion todivide the marking grid into a number of segments, each of whichcontains an elongated aperture 952. Each of the guidelines in the set oflateral-positioning guidelines 950 can be identified by a unique value,i.e., a visual indicator, for ease of identification/differentiation. Inthis illustrative embodiment, the unique values are arranged along thetop edge. The set of lateral-positioning guidelines 950 can be used todetermine a lateral-positioning coordinate in a manner that is known inthe art. The set of longitudinal-positioning guidelines 908 is arrangedin a stair-step fashion, as described in more detail in FIGS. 1A and 1B,and can be used to determine a longitudinal-positioning coordinate in amanner that was described in more detail in FIG. 2 . The marking grid900 can be applied to a patient in a manner similar to the methodologydescribed in in FIG. 7 . Further, the resultant radiographic image issimilar to the radiographic image 800 in FIG. 8 , and the manner inwhich a location can be determined, e.g., for biopsy needle placement,is determined similarly and will not be repeated for the sake ofbrevity.

In some embodiments, the marking grid 900 also includes notation areas954 a and 954 b, which can be used to write down position information,such as depth, lateral position, and/or longitudinal position which maybe conveyed to a user in close proximity to the patient.

In this illustrative embodiment in FIGS. 9A and 9B, the first elongatedaperture 952 is wider than the remaining elongated apertures 952.Conventionally available marking grids utilized a wider elongatedaperture on one side to provide context for differentiating between theleft side and the right side. The marking grid 900 in FIGS. 9A and 9Balso includes the wider elongated aperture on one side to help usersfamiliar with the conventional marking grids to properly align themarking grid 900. However, in another embodiment, all the elongatedapertures 952 have the same width, as described in FIG. 11 .

FIG. 10 is a schematic depicting a plan view of a marking grid with aset of lateral-positioning guidelines and a set oflongitudinal-positioning guidelines in accordance with yet anotherillustrative embodiment. The marking grid 1000 is similar to markinggrid 900 with the exception of the set of longitudinal-positioningguidelines 1008 differs. In particular, the set of longitudinalpositioning guidelines 1008 is arranged like the set oflongitudinal-positioning guidelines 508 in FIG. 5 .

FIG. 11 is a schematic depicting a plan view of a marking grid with aset of lateral-positioning guidelines and a set oflongitudinal-positioning guidelines in accordance with yet anotherillustrative embodiment. The marking grid 1100 is similar to markinggrid 1000 with the exception that each of the plurality of elongatedapertures 1152 have the same width.

FIGS. 12 and 13 are drawings depicting a plan view and a cross-sectionalview, respectively, of a marking grid with a set of lateral-positioningguidelines and a set of longitudinal-positioning guidelines inaccordance with yet another illustrative embodiment.

The marking grid 1200 includes a substrate 1202, which is like substrate102 in FIGS. 1A and 1B. Further, the substrate 1202 has a first side1202 a and a second side 1202 b that is at least partially covered by anadhesive 1204. The adhesive 1204 adheres the substrate 1202 toreleasable backing material 1206 that can be removed prior to use. Thesubstrate 1202 a supports the set of lateral-positioning guidelines 1250and the set of longitudinal-positioning guidelines 1208. As previouslydescribed in various earlier embodiments, the substrate 1202 can beformed from a substantially radiolucent material, whereas the set oflateral-positioning guidelines 1250 and the set oflongitudinal-positioning guidelines 1208 can be formed from asubstantially radiopaque material to provide a sufficient contrastbetween the substrate 1202 and the positioning guidelines 1250 and 1208on a radiographic image.

In this non-limiting embodiment in FIGS. 12 and 13 , the set oflateral-positioning guidelines 1250 includes seven elongated guidelinesof generally equal length, arranged in parallel fashion to divide themarking grid into a number of segments, each of which contains anelongated aperture 1252. Each of the guidelines in the set oflateral-positioning guidelines 1250 can be identified by a unique value,i.e., a visual indicator, for ease of identification/differentiation. Inthis illustrative embodiment, the unique values are arranged along thebottom edge. The set of lateral-positioning guidelines 1250 can be usedto determine a lateral-positioning coordinate in a manner that is knownin the art.

The set of longitudinal-positioning guidelines 1208 includes a set ofreference lines 1208 a and an auxiliary guideline 1208 b that is apartfrom the set of reference lines 1208 a. In this illustrative embodimentin FIGS. 12 and 13 , the auxiliary guideline 1208 b is angled relativeto the set of reference lines 1208 a, and the set of reference lines1208 a includes two reference lines positioned in close proximity toeach other, which allows for easy differentiation from the set oflateral-positioning guidelines 1250 in a radiographic image. In oneembodiment, the phrase “close proximity” means that the two referencelines are touching, or just barely touching so that they that theyappear as two distinct reference markers in a radiographic image. Inanother embodiment, the phrase “close proximity” also means a distancethat is less than the distance between each of the set oflateral-positioning guidelines 1250.

In one embodiment, the auxiliary guideline 1208 b has a distinguishingfeature that allows it to be easily differentiated from the plurality ofguidelines that form the set of lateral-positioning guidelines 1250. Forexample, the auxiliary guideline 1208 b can have a larger diameter, adifferent shape, a different radiopacity, or different layers havingdifferent radiopacities. In the non-limiting embodiment in FIGS. 12 and13 the auxiliary guideline 1208 b has a square cross-section with alower radiopacity than the set of lateral-positioning guidelines 150,which facilitates differentiation.

The marking grid 1200 also includes an index 1210 printed on the markinggrid 1200 that can be used to determine a longitudinal-positioningcoordinate on a patient once the longitudinal-positioning coordinate isidentified from a radiographic image, as will be described in moredetail below with reference to the cross-sectional view of marking grid1200 shown in FIG. 13 .

The cross-sectional view of marking grid 1200 in FIG. 13 is similar tothe depiction of the marking grid 1200 in a radiographic image taken ina transverse plane corresponding to line 13-13 in FIG. 12 . Thecross-sectional view depicts each of the guidelines that form the set oflateral-positioning guidelines 1250, which can be used to determine alateral-positioning coordinate in a manner known to those havingordinary skill in the art. A distance d between the set of referencelines 1208 a and the auxiliary guideline 1208 b can be determined fromthe radiographic image and used to determine a correspondinglongitudinal-positioning coordinate, which can then be identified and/ormarked on a patient's skin with reference to the various visualindicators on marking grid 1200.

In one embodiment, a known relationship between the set of referencelines 1208 a and the auxiliary guideline 1208 b can be used to easilydetermine a distance between the set of reference lies 1208 a and theauxiliary guideline 1208 b for easily determining alongitudinal-positioning coordinate without the need for measurement.For example, the marking grid 1200 can be configured such that the setof reference lines 1208 a is considered a vertical axis in a Cartesiancoordinate system (i.e., a Y-axis), and an imaginary line spanning themarking grid 1200 along the bottom and in the transverse direction,i.e., passing through the ends of each of the lateral-positioningguidelines 1250, is considered a horizontal axis in a Cartesiancoordinate system (i.e., an X-axis). Further, the auxiliary line 1208 bcan be configured with a slope that satisfies the equation y=mx+b wherethe slope (x) is 1 and the y-intercept (b) is 0. Thus, with reference toFIG. 13 , the distance d on the X-axis also corresponds to the samedistance on the Y-axis, which is the longitudinal-positioning coordinatefor determining the location on a patient's skin.

FIGS. 14 and 15 are drawings depicting a plan view and a cross-sectionalview, respectively, of a marking grid with a set of lateral-positioningguidelines and a set of longitudinal-positioning guidelines inaccordance with yet another illustrative embodiment. The marking grid1400 is similar to marking grid 1200 except that the set of referencelines 1408 a is a single line having a square cross-section. The squarecross-section of reference line 1408 a can be easily differentiated fromthe circular cross-sections of the guidelines that form the set oflateral-positioning guidelines 1450.

In each of the embodiments depicted in FIGS. 9-15 , the marking gridswere depicted as having a set of elongated apertures disposed throughoutthe marking grid, which allows for marking a patient's skin andconducting the biopsy needle insertion without removing the markinggrid. However, in another embodiment, the elongated apertures may beomitted entirely and replaced with a semipermeable material, such as apaper or fabric, that permits transfer of ink through to a patient'sskin and which permits biopsy needle insertion without removing themarking grid. In this alternate embodiment, the substrate may bepartially or entirely formed from the semipermeable material.

FIG. 16 illustrates a flowchart of a process for location identificationusing a marking grid in accordance with an illustrative embodiment.Flowchart 1600 begins at Step 1602 by identifying, from a radiographicimage, a target internal structure. In Step 1604, a lateral-positioningcoordinate is identified from reference markers associated with the setof lateral-positioning guidelines.

In Step 1606, a longitudinal-positioning coordinate is identified fromreference markers associated with the set of longitudinal-positioningguidelines. In one embodiment, the set of longitudinal-positioningguidelines includes a plurality of guidelines configured to indicate alongitudinal position within the area bounded by the marking grid basedon a number of guidelines that appear in the cross-section of themarking grid. In another embodiment, the set of longitudinal-positioningguidelines includes a set of reference guidelines and an auxiliaryguideline, the longitudinal-positioning coordinate determined based on adistance between the set of reference guidelines and the auxiliaryguideline.

In Step 1608, a location for needle insertion is determined withpositional information derived from the radiographic image. In someembodiments, an optional depth measurement can be determined from theradiographic image and used for biopsy needle insertion for tissueextraction.

Additional Embodiments

The following descriptive embodiments are offered in further support ofthe disclosed invention:

In a first embodiment, novel aspects of the present disclosure aredirected to a longitudinal-positioning indicator that comprises asubstrate including a first side and a second side, wherein the secondside is at least partially coated with an adhesive; and a set oflongitudinal-positioning guidelines secured with the substrate, whereinthe set of longitudinal-positioning guidelines is configured to indicatea position along a length of the longitudinal-positioning guidelinesbased on a cross-section of the longitudinal-positioning indicator takensubstantially orthogonally to the set of longitudinal-positioningguidelines.

In another aspect of the first embodiment, the longitudinal-positioningindicator comprises a substrate including a first side and a secondside, wherein the second side is at least partially coated with anadhesive; a set of longitudinal-positioning guidelines secured with thesubstrate, wherein the set of longitudinal-positioning guidelines isconfigured to indicate a position along a length of thelongitudinal-positioning guidelines based on a cross-section of thelongitudinal-positioning indicator taken substantially orthogonally tothe set of longitudinal-positioning guidelines; and further comprisesone or more limitations selected from the following:

wherein the set of longitudinal-positioning guidelines is disposed onthe first side of the substrate;

wherein the substrate has a first radiopacity, and the set oflongitudinal-positioning guidelines has a second radiopacity that isgreater than the first radiopacity;

wherein the set of longitudinal-positioning guidelines is formed from aplurality of guidelines of different lengths;

wherein the plurality of guidelines of different lengths are spacedapart and oriented substantially parallel to each other, and each of theplurality of guidelines is aligned at one end and arranged based onlength;

wherein the longitudinal-positioning indicator further comprises anindex with a plurality of demarcations, each of the plurality ofdemarcations corresponding to a length of a guideline in the pluralityof guidelines;

wherein the substrate of the longitudinal-positioning indicator furthercomprises an elongated body portion for the set oflongitudinal-positioning guidelines and a margin portion extending fromthe elongated body portion;

wherein the margin portion includes a set of tabs; and

wherein the longitudinal-positioning indicator further comprises areleasable backing secured to the substrate by the adhesive.

In a second embodiment, novel aspects of the present disclosure aredirected to a marking grid that comprises a substrate including a firstside and a second side, wherein the second side is at least partiallycoated with an adhesive; a set of longitudinal-positioning guidelinessupported by the substrate, and wherein the set of lateral-positioningguidelines and the set of longitudinal-positioning guidelines areconfigured to provide a pair of orthogonal coordinates that indicate alocation within an area bounded by the marking grid, the location basedon a cross-section of the marking grid taken substantially orthogonallyto the set lateral-positioning guidelines.

In another aspect of the second embodiment, novel aspects of the presentdisclosure are directed to a marking grid that comprises a substrateincluding a first side and a second side, wherein the second side is atleast partially coated with an adhesive; a set oflongitudinal-positioning guidelines supported by the substrate, whereinthe set of lateral-positioning guidelines and the set oflongitudinal-positioning guidelines are configured to provide a pair oforthogonal coordinates that indicate a location within an area boundedby the marking grid, the location based on a cross-section of themarking grid taken substantially orthogonally to the setlateral-positioning guidelines; and further comprises one or morelimitations selected from the following:

wherein the substrate comprises a set of elongated aperturesinterspersed with the set of lateral-positioning guidelines inalternating fashion;

wherein the set of longitudinal-positioning guidelines includes aplurality of guidelines, and wherein the set of longitudinal-positioningguidelines is configured to indicate a longitudinal position within thearea bounded by the marking grid based on a number of guidelines thatappear in the cross-section of the marking grid;

wherein the plurality of guidelines includes guidelines of a differentlength, arranged in a stair-step configuration;

wherein the marking grid further comprises an index with a plurality ofdemarcations, each of the plurality of demarcations corresponding to alength of a guideline in the plurality of guidelines;

wherein the set of longitudinal-positioning guidelines includes a set ofreference guidelines and an auxiliary guideline, and wherein alongitudinal-positioning coordinate is determined based on a distancebetween the set of reference guidelines and the auxiliary guideline;

wherein the set of reference guidelines includes two parallel lines, andwherein the auxiliary guideline has a cross-section that differs fromcross-sections of the two parallel lines; and

wherein the set of reference guidelines includes one line, and where theset of reference guidelines and the auxiliary guideline have rectangularcross-sections.

In a third embodiment, novel aspects of the present disclosure aredirected to a method for identifying a location for needle insertioninto a patient within an area defined by a marking grid, the markinggrid including a set of lateral-positioning guidelines and a set oflongitudinal-positioning guidelines configured to provide referencemarkers based on a cross-section of the marking grid taken substantiallyorthogonally to the set of lateral-positioning guidelines, the methodcomprising: identifying, from a radiographic image, a target internalstructure; identifying, from reference markers associated with the setof lateral-positioning guidelines, a lateral-positioning coordinate forthe target internal structure; identifying, from reference markersassociated with the set of longitudinal-positioning guidelines, alongitudinal-positioning coordinate for the target internal structure;and determining, with reference to visual indicators on the markinggrid, a location for the needle insertion using thelongitudinal-positioning coordinate and the lateral-positioningcoordinate.

In another aspect of the third embodiment, novel aspects of the presentdisclosure are directed to a method for identifying a location forneedle insertion into a patient within an area defined by a markinggrid, the marking grid including a set of lateral-positioning guidelinesand a set of longitudinal-positioning guidelines configured to providereference markers based on a cross-section of the marking grid takensubstantially orthogonally to the set of lateral-positioning guidelines,the method comprising: identifying, from a radiographic image, a targetinternal structure; identifying, from reference markers associated withthe set of lateral-positioning guidelines, a lateral-positioningcoordinate for the target internal structure; identifying, fromreference markers associated with the set of longitudinal-positioningguidelines, a longitudinal-positioning coordinate for the targetinternal structure; determining, with reference to visual indicators onthe marking grid, a location for the needle insertion using thelongitudinal-positioning coordinate and the lateral-positioningcoordinate; and further comprises one or more limitations selected fromthe following:

wherein the set of longitudinal-positioning guidelines includes aplurality of guidelines, and wherein the set of longitudinal-positioningguidelines is configured to indicate a longitudinal position within thearea bounded by the marking grid based on a number of guidelines thatappear in the cross-section of the marking grid; and

wherein the set of longitudinal-positioning guidelines includes a set ofreference guidelines and an auxiliary guideline, and wherein alongitudinal-positioning coordinate is determined based on a distancebetween the set of reference guidelines and the auxiliary guideline.

Although embodiments of the invention have been described with referenceto several elements, any element described in the embodiments describedherein are exemplary and can be omitted, substituted, added, combined,or rearranged as applicable to form new embodiments. A skilled person,upon reading the present specification, would recognize that suchadditional embodiments are effectively disclosed herein. Additionally,where an embodiment is described herein as comprising some element orgroup of elements, additional embodiments can consist essentially of orconsist of the element or group of elements. Also, although theopen-ended term “comprises” is generally used herein, additionalembodiments can be formed by substituting the terms “consistingessentially of” or “consisting of.”

While this disclosure has been particularly shown and described withreference to preferred embodiments, it will be understood by thoseskilled in the art that various changes in form and detail may be madetherein without departing from the spirit and scope of the invention.The inventors expect skilled artisans to employ such variations asappropriate, and the inventors intend the invention to be practicedotherwise than as specifically described herein. Accordingly, thisinvention includes all modifications and equivalents of the subjectmatter recited in the claims appended hereto as permitted by applicablelaw. Moreover, any combination of the above-described elements in allpossible variations thereof is encompassed by the invention unlessotherwise indicated herein or otherwise clearly contradicted by context.

We claim:
 1. A longitudinal-positioning indicator comprising: asubstrate including a first side and a second side, wherein the secondside is at least partially coated with an adhesive, and wherein thesubstrate has a width extending in a first direction and a lengthextending in a second direction substantially orthogonal to the firstdirection; and a set of longitudinal-positioning guidelines secured withthe substrate, wherein: the set of longitudinal-positioning guidelineshas a length that extends in the second direction, and the set oflongitudinal-positioning guidelines is configured to indicate a relativeposition along the length of the longitudinal-positioning guidelines inthe second direction based on a cross-section of thelongitudinal-positioning indicator taken substantially orthogonally tothe second direction.
 2. The longitudinal-positioning indicator of claim1, wherein the set of longitudinal-positioning guidelines is disposed onthe first side of the substrate.
 3. The longitudinal-positioningindicator of claim 1, wherein: the substrate has a first radiopacity;and the set of longitudinal-positioning guidelines has a secondradiopacity that is greater than the first radiopacity.
 4. Thelongitudinal-positioning indicator of claim 1, wherein the set oflongitudinal-positioning guidelines is formed from a plurality ofguidelines of different lengths.
 5. The longitudinal-positioningindicator of claim 4, wherein: the plurality of guidelines of differentlengths are spaced apart and oriented substantially parallel to eachother; and each of the plurality of guidelines is aligned at one end andarranged based on length.
 6. The longitudinal-positioning indicator ofclaim 5, further comprising: an index with a plurality of demarcations,each of the plurality of demarcations corresponding to a length of aguideline in the plurality of guidelines.
 7. Thelongitudinal-positioning indicator of claim 1, wherein the substratefurther comprises: an elongated body portion for the set oflongitudinal-positioning guidelines; and a margin portion extending fromthe elongated body portion.
 8. The longitudinal-positioning indicator ofclaim 7, wherein the margin portion includes a set of tabs.
 9. Thelongitudinal-positioning indicator of claim 1, further comprising: areleasable backing secured to the substrate by the adhesive.
 10. Amarking grid for use in radiographic imaging, the marking gridcomprising: a substrate including a first side and a second side,wherein the second side is at least partially coated with an adhesive; aset of lateral-positioning guidelines supported by the substrate; and aset of longitudinal-positioning guidelines supported by the substrate,and wherein the set of lateral-positioning guidelines and the set oflongitudinal-positioning guidelines are configured to provide a pair oforthogonal coordinates that indicate a location within an area boundedby the marking grid, the location based on a cross-section of themarking grid taken substantially orthogonally to the setlateral-positioning guidelines.
 11. The marking grid of claim 10,wherein the substrate comprises a set of elongated aperturesinterspersed with the set of lateral-positioning guidelines inalternating fashion.
 12. The marking grid of claim 10, wherein the setof longitudinal-positioning guidelines includes a plurality ofguidelines, and wherein the set of longitudinal-positioning guidelinesis configured to indicate a longitudinal position within the areabounded by the marking grid based on a number of guidelines that appearin the cross-section of the marking grid.
 13. The marking grid of claim12, wherein the plurality of guidelines includes guidelines of adifferent length, arranged in a stair-step configuration.
 14. Themarking grid of claim 12, wherein the marking grid further comprises: anindex with a plurality of demarcations, each of the plurality ofdemarcations corresponding to a length of a guideline in the pluralityof guidelines.
 15. The marking grid of claim 10, wherein the set oflongitudinal-positioning guidelines includes a set of referenceguidelines and an auxiliary guideline, and wherein alongitudinal-positioning coordinate is determined based on a distancebetween the set of reference guidelines and the auxiliary guideline. 16.The marking grid of claim 15, wherein the set of reference guidelinesincludes two parallel lines, and wherein the auxiliary guideline has across-section that differs from cross-sections of the two parallellines.
 17. The marking grid of claim 15, wherein the set of referenceguidelines includes one line, and where the set of reference guidelinesand the auxiliary guideline have rectangular cross-sections.
 18. Amethod for identifying a location for needle insertion into a patientwithin an area defined by a marking grid, the marking grid including aset of lateral-positioning guidelines and a set oflongitudinal-positioning guidelines configured to provide referencemarkers based on a cross-section of the marking grid taken substantiallyorthogonally to the set of lateral-positioning guidelines, the methodcomprising: identifying, from a radiographic image, a target internalstructure; identifying, from reference markers associated with the setof lateral-positioning guidelines, a lateral-positioning coordinate forthe target internal structure; identifying, from reference markersassociated with the set of longitudinal-positioning guidelines, alongitudinal-positioning coordinate for the target internal structure;and determining, with reference to visual indicators on the markinggrid, the location for the needle insertion using thelongitudinal-positioning coordinate and the lateral-positioningcoordinate.
 19. The method of claim 18, wherein the set oflongitudinal-positioning guidelines includes a plurality of guidelines,and wherein the set of longitudinal-positioning guidelines is configuredto indicate a longitudinal position within the area bounded by themarking grid based on a number of guidelines that appear in thecross-section of the marking grid.
 20. The method of claim 18, whereinthe set of longitudinal-positioning guidelines includes a set ofreference guidelines and an auxiliary guideline, and wherein alongitudinal-positioning coordinate is determined based on a distancebetween the set of reference guidelines and the auxiliary guideline.